Managed Care Plans for the Insured

Abstract This paper is about an article I read about how managed care plans were created for uninsured patients of New Mexico back in 1997. The University of New Mexico Health science center felt that if they created this managed care plan that it would reduce the use of the emergency room and cost of care for the patients. By utilizing preventive care services this would actually decrease the unnecessary use of the emergency room for preventive and non-urgent care. Managed care plans for the uninsured: A program like this is very necessary in areas of which many people have no health coverage at all.

When people do not have health coverage they tend to go straight to the emergency room for things regular things such as a cold or just to check and make sure they are ok. Most emergency rooms cannot deny you from care. When uninsured patients do this they are then billed and never pay the hospital they lose out on money for services that they had to provide. Repeated use of the emergency room becomes costly to any hospital. With a managed care plan in place for the uninsured they would be able to utilize the plan for preventive care and urgent care.

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Studies show that when patients have access to preventive care the will be less likely to go to the emergency room for services that they can just go to their primary care physician for. I think they would come out a lot cheaper having a plan like this where everyone can receive the proper health care service they need. This takes a lot of planning and budgeting of the state/county and the facility to come together to make sure a program like this can run. The patients that would utilize a service like this have not a lot of income so it’s like your providing services for free.

But you can have the patients pay small copay for PCP and specialist office visits. Yes there is Medicaid but not everyone can still obtain it. You have instances were the child was approved but the mother wasn’t and so where does that leave her, without coverage or when you have a working individual who’s job does not provide medical coverage or if they do it is very expensive. Programs like this have to be state or county funded depending on the area but I believe a lot of the larger hospital systems here in NY can do it like North Shore Long Island Jewish Hospital, Mount Sinai Hospital, NYU Hospital and NY Presbyterian.

These hospitals are privately funded and can get grants and incentives to establish a program like this to pilot it and see if it will work and cut down on a lot of medical coverage that is being done for free. The providers that they can use to see the patients could be medical students who are still practicing in the field and need the experience. I believe that everyone deserves to have the proper health care coverage provided to them to live a healthy life no matter who you are. Managed care plans are also could to traffic the use of doctors and facilities unnecessarily.

In today’s society more and more people do not have access to healthcare and this leads to a wide range of problems which a lot of them can be curbed if everyone was given access to the basics which is preventive care. It’s a long hard road towards making sure that every individual is given proper care and coverage. In the article it showed that this type of plan worked and cut hospital cost especially in the emergency room. Managed care plan work and are manageable for patients. If you need a physical and are sick you go to your primary care physician.

If you need to see a specialist than your PCP will refer you. Maternity care for women will be covered and pediatric care to children. Basic services can save a city and state a lot. We spend money on many of other things to that I feel are unnecessary References Academic Medicine: April 2000 – Volume 75 – Issue 4 – p 323-330, Institutional Issues: Articles Managed Care for Uninsured Patients at an Academic Health Center: A Case Study Kaufman, Arthur MD; Derksen, Daniel MD; McKernan, Stephen; Galbraith, Pamela RN; Sava, Saverio MD; Wills, John MD; Fingado, Elizabeth.

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